NPI | 1548226376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61249297) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 8232) |
363LF0000X Nurse Practitioner, Family (Licence: TN RN133351) | |
213E00000X Podiatrist (Licence: WA AP61249297) | |
Enumeration Date | 2006-04-21 |
Last Update Date | 2022-06-22 |